Children undergo numerous painful medical procedures, which can result in a host of short- and long-term negative repercussions. In addition, the patients' parents and the medical staff experience undue collateral distress. It is heartening that a number of interventions have been shown to reduce the procedural distress experienced by the child, parent, and staff. However, these interventions have not been well disseminated into pediatric practice, which is likely due to their high costs and low feasibility. The purpose of the proposal is to evaluate a pediatric pain management package, which has a high potential for widespread use in health care facilities. Participants will include 150 4- to 6-year-olds receiving preschool vaccinations and their parents. Families will be randomly assigned to one of three conditions: Training and Distraction, Distraction Alone, or Typical Care. Via an interactive computer training program, families assigned to the Training and Distraction condition will learn parent coaching and child coping skills to use during the noxious event. These children will also be shown a distracting movie during the immunization. Children in the Distraction Alone condition will not receive the pre-procedure training but will be shown the movie. Typical Care participants will neither receive training nor the movie. Parent and nurse coaching behavior will be quantified with a behavior observation scale. Child anxiety and pain will be assessed with self-report, parent-report, nurse report, a behavior observation scare, and heart rate. Parent-report, nurse-report, and heart rate will estimate parent anxiety; and nurses will rate their own distress. Parents and nurses will provide satisfaction ratings for the three conditions. A knowledge test, used at the time of the procedure and 3-months later, will evaluate parents' understanding and retention of coaching behaviors shown in research to be helpful and not helpful to children during painful events. Results might support an innovative intervention that can be used to train parents and children in proven pain management skills to use during an invasive medical procedure. [unreadable] [unreadable]